Search

Active commuting can be beneficial for health. We examined whether active commuting by walking or cycling was associated with a lower risk of sickness absence in a Finnish public sector cohort of 28 485 employees. We used negative binomial regression to test associations of weekly active commuting in kilometers (no, low, moderate, and high dose) with all‐cause sickness absence. Sickness absence data from employers registers comprised the number of (1) sickness absence days, (2) short (1–9 days) and (3) long (≥ 10 days) sickness absence episodes during 12‐ and 24‐month follow‐ups. The models were adjusted for sociodemographic factors, lifestyle risk factors, and previous sickness absence. To demonstrate absolute risk, we calculated sex‐ and age‐adjusted incidence for sickness absence per 100 person years for each active commuting exposure group. The associations of cycling and walking were additionally studied in separate analyses. Compared to passive commuters (no active commuting), high dose of active commuting (mean of 61 km/week) was associated with an 8%–12% lower relative risk of sickness absence days and an 18% lower relative risk of long episodes. The absolute rate of sickness absence per 100 person‐years was up to 452 days and 10 long episodes lower in the high‐dose active commuters group. In the further analyses separating cyclists and walkers, similar reduced risks were observed only among high‐dose cyclists. Our findings suggest that regular active commuting by bicycle has potential for reducing sickness absence by reducing the risk of long sickness absence episodes. [ABSTRACT FROM AUTHOR]

Purpose: To examine how the level of perceived work ability and its changes over time are associated with the risk of full disability pension (DP) among those receiving partial DP. Methods: We retrieved survey data on perceived work ability and covariates (sociodemographic factors and health behaviors) from a cohort study of Finnish public sector employees at two time points: 2008 and 2012 and linked them with register data on DP obtained from the Finnish Centre for Pensions up to the end of 2018. Participants had begun receiving partial DP in 2008 and responded to either the 2008 survey (n = 159) or both surveys (n = 80). We used Cox regression for the analyses. Results: During the follow-up, 61 (38%) of those receiving partial DP transitioned to full DP. Those with perceived poor work ability were at a higher risk of full DP (HR 1.93; 95% CI 1.11–3.38) than those with at least moderate work ability, after adjustment for covariates. During four years of receiving partial DP, perceived work ability decreased among 36% of the participants, and remained unchanged or improved among 64%. Change in work ability was not associated with a risk of full DP. Conclusion: Among those receiving partial DP, perceived poor work ability was a risk factor for full DP. Our findings highlight the importance of monitoring the level of perceived work ability of those receiving partial DP to enable identifying individuals at an increased risk of full DP. [ABSTRACT FROM AUTHOR]

Background Stimulating activities are associated with a decreased risk of dementia. However, the extent to which this reflects a protective effect of activity or non-participation resulting from dementia is debated. We investigated the association of stimulating leisure-time activity in late adulthood with the risk of dementia across up to two decades' follow-up. Methods We used data from five prospective cohort studies from Finland and Sweden. Mental, social, outdoor, consumptive and physical leisure-time activities were self-reported. Incident dementia was ascertained from clinical diagnoses or healthcare and death registers. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results Of the 33 263 dementia-free individuals aged ≥50 years at baseline, 1408 had dementia during a mean follow-up of 7.0 years. Active participation in mental (HR: 0.52, 95% CI: 0.41 to 0.65), social (HR: 0.56 95% CI: 0.46 to 0.72), outdoor (HR: 0.70, 95% CI: 0.58 to 0.85), consumptive (HR: 0.67, 95% CI: 0.53 to 0.94) and physical (HR: 0.62, 95% CI: 0.51 to 0.75) activity, as well as variety (HR: 0.54, 95% CI: 0.43 to 0.68) and the overall frequency of activity (HR: 0.41, 95% CI: 0.34 to 0.49) were associated with a reduced risk of dementia in <10 years' follow-up. In ≥10 years' follow-up all associations attenuated toward the null. Conclusion Stimulating leisure-time activities are associated with a reduced risk of dementia in short-term but not long-term follow-up. These findings may reflect a reduction in leisure-time activity following preclinical dementia or dilution of the association over time. [ABSTRACT FROM AUTHOR]

Aim: To determine the extent to which level of active commute mode use is associated with self-rated health and work ability. Methods: The data were sourced from the Finnish Public Sector Study survey in 2020 (n = 38,223). The associations between active commuting – assessed with the frequency of using active commute modes – and self-rated health and work ability were examined with negative binomial regression analyses. Passive commuting and low-to-moderate levels of active commuting were compared with active commuting, and the models were adjusted for sociodemographic factors, working time mode, and lifestyle risk factors. We also assessed separate associations between walking and cycling as a mode of commuting by additionally considering the commuting distance and the outcomes. Results: After adjustment, when using active commuters as a reference, passive commuters had a 1.23-fold (95% confidence intervals (CI) 1.19 to 1.29) risk of suboptimal self-rated health and a 1.18-fold (95% CI 1.13 to 1.22) risk of suboptimal work ability. More frequent and/or longer distance by foot and especially by bicycle, was positively associated with health and work ability. Never commuting by bicycle was associated with a 1.65-fold (95% CI 1.55 to 1.74) risk of suboptimal health and a 1.27-fold (95% CI 1.21 to 1.34) risk of suboptimal work ability when using high-dose bicycle commuting as a reference. Conclusions: Passive commuting was associated with suboptimal self-rated health and suboptimal work ability. Our results suggest that using active commute modes, particularly cycling, may be beneficial for employee health and work ability. [ABSTRACT FROM AUTHOR]

Background: Prior studies suggest that physical activity lowers circulating C-reactive protein (CRP) levels. However, little is known about the association between regular active commuting, i.e. walking or cycling to work, and CRP concentrations. This study examines whether active commuting is associated with lower CRP. Methods: We conducted a cross-sectional study using population-based FINRISK data from 1997, 2002, 2007 and 2012. Participants were working adults living in Finland (n = 6208; mean age = 44 years; 53.6% women). We used linear and additive models adjusted for potential confounders to analyze whether daily active commuting, defined as the time spent walking or cycling to work, was associated with lower high-sensitivity (hs-) CRP serum concentrations compared with passive commuting. Results: We observed that daily active commuting for 45 min or more (vs. none) was associated with lower hs-CRP [% mean difference in the main model: -16.8%; 95% confidence interval (CI) -25.6% to -7.0%), and results were robust to adjustment for leisure-time and occupational physical activity, as well as diet. Similarly, active commuting for 15-29 min daily was associated with lower hs-CRP in the main model (-7.4; 95% CI -14.1 to -0.2), but the association attenuated to null after further adjustments. In subgroup analyses, associations were only observed for women. Conclusions: Active commuting for at least 45 min a day was associated with lower levels of low-grade inflammation. Promoting active modes of transport may lead not only to reduced emissions from motorized traffic but also to population-level health benefits. [ABSTRACT FROM AUTHOR]

Background We examined how reducing work-related psychosocial stressors affected long-term sickness absence of younger and older employees. Methods We used data from 43 843 public sector employees in Finland who participated in surveys in 2018 and 2020. We assessed psychosocial factors, such as job demands, job control, work effort, job rewards and worktime control. We obtained sickness absence data from registers for spells longer than 10 consecutive working days. We applied age-specific propensity score weighting and generalized linear models to estimate the effects of changes in psychosocial factors between 2018 and 2020 on sickness absence in 2020. Results Among employees under 50 years, increasing job rewards by 1 SD reduced the risk of sickness absence by 17% [risk ratio (RR) 0.83, 95% CI 0.72–0.96]. Among employees aged 50 years or older, decreasing job demands by 1 SD reduced the risk of sickness absence by 13% (RR 0.87, 95% CI 0.78–0.98), and increasing job control by 1 SD reduced the risk by 12% (RR 0.88, 95% CI 0.76–1.01). Changes in efforts and worktime control had no significant associations with sickness absence. Conclusions Reducing psychosocial stressors can lower the occurrence of long-term sickness absence, but the associations differ by age group. Younger workers benefit more from enhancing job rewards, while older workers benefit more from lowering job demands and increasing job control. To establish the causal impact of psychosocial risk reduction on sickness absence across age groups, future research should employ randomized controlled trials as the methodological approach. [ABSTRACT FROM AUTHOR]

The extent to which school neighbourhood affects teachers' work commitment is poorly known. In the current study, we investigated whether school neighbourhood socio-economic characteristics predicted teachers' organizational and professional commitment. Primary school teachers (n?=?1042) responded to surveys in 2000-2001 (baseline) and 2004 (follow-up). Their responses were linked to records of the school neighbourhood income and unemployment levels obtained from nationwide registers. Teachers working in areas with a high income level and low unemployment rate had longer job tenure and higher probability of organizational (school) commitment at follow-up compared to teachers working in areas with a low income level or high unemployment rate. Less consistent associations were found for professional commitment. These findings suggest that school neighbourhood characteristics may affect teachers' work commitment, especially their organizational commitment. Further research is needed to determine whether this increases inequalities in children's learning opportunities.

BACKGROUND: Climate change scenarios illustrate various pathways in terms of global warming ranging from “sustainable development” (Shared Socioeconomic Pathway SSP1-1.9), the best-case scenario, to ‘fossil-fueled development’ (SSP5-8.5), the worst-case scenario. OBJECTIVES: We examined the extent to which increase in daily average urban summer temperature is associated with future cause-specific mortality and projected heat-related mortality burden for the current warming trend and these two scenarios. METHODS: We did an observational cohort study of 363,754 participants living in six cities in Finland. Using residential addresses, participants were linked to daily temperature records and electronic death records from national registries during summers (1 May to 30 September) 2000 to 2018. For each day of observation, heat index (average daily air temperature weighted by humidity) for the preceding 7 d was calculated for participants’ residential area using a geographic grid at a spatial resolution of 1 km × 1 km. We examined associations of the summer heat index with risk of death by cause for all participants adjusting for a wide range of individual-level covariates and in subsidiary analyses using case-crossover design, computed the related period population attributable fraction (PAF), and projected change in PAF from summers 2000–2018 compared with those in 2030–2050. RESULTS: During a cohort total exposure period of 582,111,979 summer days (3,880,746 person-summers), we recorded 4,094 deaths, including 949 from cardiovascular disease. The multivariable-adjusted rate ratio (RR) for high (≥21°C) vs. reference (14-15°C) heat index was 1.70 (95% CI: 1.28, 2.27) for cardiovascular mortality, but it did not reach statistical significance for noncardiovascular deaths, RR=1.14 (95% CI: 0.96, 1.36), a finding replicated in case-crossover analysis. According to projections for 2030-2050, PAF of summertime cardiovascular mortality attributable to high heat will be 4.4% (1.8%-7.3%) under the sustainable development scenario, but 7.6% (3.2%-12.3%) under the fossil-fueled development scenario. In the six cities, the estimated annual number of summertime heat-related cardiovascular deaths under the two scenarios will be 174 and 298 for a total population of 1,759,468 people. DISCUSSION: The increase in average urban summer temperature will raise heat-related cardiovascular mortality burden. The estimated magnitude of this burden is >1.5 times greater if future climate change is driven by fossil fuels rather than sustainable development. [ABSTRACT FROM AUTHOR]

Background: Studies have reported higher levels of absenteeism due to illness among special education teachers compared to other teachers, but it is not known which factors might contribute to this difference. We examined whether health, health behaviors, and exposure to violence at work differed between special education and general education teachers in Finnish basic education. Methods: Survey data from 5760 general and special education teachers were analyzed with multilevel logistic models adjusted for individual- and school-level confounding factors. Results: No difference was found between the health behaviors of general and special education teachers. The differences in physical and mental health between the two groups were also relatively small. With regard to work-related violence, however, male special education teachers were 3 times more likely to be exposed to mental abuse, and 5 times more likely to be exposed to physical violence when compared to their male colleagues in general education. Although female special educators were also at an increased risk of mental abuse and physical violence compared to their female general teacher colleagues, their odds ratios for such an encounter were smaller (2- and 3-fold, respectively) than those of male special education teachers. The school-level variance of physical violence toward teachers was large, which indicates that while most schools have little physical violence toward teachers, schools do exist in which teachers' exposure to violence is common. Conclusions: These findings suggest that special education teachers may benefit from training for handling violent situations and interventions to prevent violence at schools. (Contains 4 tables.)

This cohort study examines data from the UK Biobank and 2 Finnish cohorts to gauge the association between depression and an array of physical conditions requiring hospital treatment. Key Points: Question: What are the most common conditions requiring hospital treatment in people with depression? Findings: In this cohort study that included 240 433 individuals, depression was associated with an increased risk of 29 hospital-treated conditions. For 12 of these conditions, there was evidence for a bidirectional relationship with depression; the highest cumulative incidence was observed for diseases of the endocrine, musculoskeletal, and circulatory systems. Meaning: In this study, the main causes of excess hospitalizations in people with depression were endocrine, musculoskeletal, and vascular diseases. Importance: Depression is associated with an increased risk of physical illness, but the most common causes of hospitalization among people with depression are unclear. Objective: To examine the association of depression with an array of physical conditions requiring hospital treatment. Design, Setting, and Participants: In this outcomewide prospective multicohort study, primary analysis was based on data from the UK Biobank, a population-based study in the United Kingdom. Analyses were repeated in an independent data set of 2 cohorts in Finland, a population-based study and an occupational cohort. Data analysis was conducted between April and September 2022. Exposures: Self-reported depression, recurrent severe major depression, recurrent moderate major depression, and a single major depressive episode. Main Outcomes and Measures: A total of 77 common health conditions ascertained from linkage data to national hospital and mortality registries. Results: The analytical sample of UK Biobank participants consisted of 130 652 individuals (71 565 women [54.8%]; 59 087 men [45.2%]; mean [SD] age at baseline, 63.3 [7.8] years). The pooled data from the Finnish replication cohorts included 109 781 participants (82 921 women [78.6%]; 26 860 men [21.4%]; mean [SD] age, 42 [10.8] years). In the main analysis, severe/moderately severe depression was associated with the incidence of 29 nonoverlapping conditions requiring hospital treatment during a 5-year follow-up. Twenty-five of these associations remained after adjustment for confounders and multiple testing (adjusted hazard ratio [HR] range, 1.52-23.03) and were confirmed in the analysis of the Finnish cohorts. These included sleep disorders (HR, 5.97; 95% CI, 3.27-10.89), diabetes (HR, 5.15; 95% CI, 2.52-10.50), ischemic heart disease (HR, 1.76; 95% CI, 1.36-2.29), chronic obstructive bronchitis (HR, 4.11; 95% CI, 2.56-6.60), bacterial infections (HR, 2.52; 95% CI, 1.99-3.19), back pain (HR, 3.99; 95% CI, 2.96-5.38), and osteoarthritis (HR, 1.80; 95% CI, 1.46-2.20). The highest cumulative incidence was observed for endocrine and related internal organ diseases (245 per 1000 persons with depression; risk difference relative to unaffected individuals: 9.8%), musculoskeletal diseases (91 per 1000 persons; risk difference, 3.7%), and diseases of the circulatory system and blood (86 per 1000 persons; risk difference, 3.9%). The cumulative incidence was lower for hospital-treated mental, behavioral, and neurological disorders (20 in 1000 persons; risk difference, 1.7%). Depression was also associated with disease progression in people with prevalent heart disease or diabetes, and for 12 conditions, there was evidence of a bidirectional relationship. Conclusions and Relevance: In this study, the most common causes of hospitalization in people with depression were endocrine, musculoskeletal, and vascular diseases, not psychiatric disorders. These findings suggest that depression should be considered as a target for the prevention of physical and mental disease. [ABSTRACT FROM AUTHOR]

Promoting physical activity can improve population health. This study aimed to examine associations of leisure‐time moderate‐to‐vigorous physical activity and active school transport with mental health, that is, symptoms of depression and anxiety, among 15‐ to 16‐year‐old adolescents. We also assessed the relationships with less‐studied outcomes, such as chronic stress and visits to school psychologist. A nationwide Finnish cohort of eighth and ninth graders from the School Health Promotion study (32 829 participants; mean age 15.4 years; 53% girls) was studied. We used logistic regression to estimate odds ratios (OR), with models adjusted for major sociodemographic, health behavior, and physical activity variables. Key findings suggest that leisure‐time moderate‐to‐vigorous physical activity is associated with better mental health in a dose–response manner. Even the smallest dose, 30 weekly minutes, was linked to 17% lower odds of chronic stress symptoms compared to inactivity (OR 0.83, 95% CI 0.71–0.96). Compared to non‐active transportation, more than 30 min of daily active school transport yielded 19% (OR 1.19, 95% CI 1.07–1.31) and 33% (OR 1.33, 95% CI 1.12–1.58) higher odds of depression symptoms and school psychologist visits, respectively. However, no associations were found for low‐to‐moderate daily active school transport levels (<30 min). This large‐scale study further highlights a positive association between leisure‐time physical activity and mental health among youth. Future research should explore what factors might explain the potential adverse mental health outcomes of active school transport. [ABSTRACT FROM AUTHOR]

Objective This study aimed to find out whether utilizing a shift schedule evaluation tool with ergonomics recommendations for working hours has favorable effects on the incidence of occupational injuries. Methods This 4-year prospective cohort study (2015-2018) consisted of a dynamic cohort of healthcare shift workers (N=29 237) from ten hospital districts and six cities in Finland. Working hour characteristics and occupational injuries were measured with daily registry data. Multilevel generalized linear model was used for the analyses, and the estimates were controlled for hierarchical structure of the data and confounders. Results Ward heads of the cities used the shift schedule evaluation tool 3.2 times more often than ward heads of the hospital districts. Overall incidence of workplace and commuting injuries did not differ between users and non-users of the evaluation tool. The incidence of dislocations, sprains, and strains was lower in the users than non-users [adjusted odds ratio (OR) 0.88, 95% confidence interval (CI) 0.78-0.99]. Approximately 13% of this association was mediated by increase in realized shift wishes and 10% by increase in single days off. In subgroup analyses, the incidence of workplace injury (OR 0.83, 95% CI 0.69-0.99), and among types of injuries, the incidence of dislocations, sprains, and strains (OR 0.69, 95% CI 0.55-0.85) and falling, slipping, tripping, or overturning (OR 0.75, 95% CI 0.58-0.99) were lower in users than non-users among employees of the cities, but no association was found among employees of the hospital districts. Conclusion The use of ergonomics recommendations for working hours is associated with a reduced risk of occupational injuries. [ABSTRACT FROM AUTHOR]

Background: In health care, the shift work is arranged as irregular work shifts to provide operational hours for 24/7 care. We aimed to investigate working hour trends and turnover in health care via identification of time-related sequences of work shifts and absences among health care employees. The transitions between the work shifts (i.e., morning, day, evening, and night shifts), and absences (days off and other leaves) over time were analyzed and the predictors of change in irregular shift work were quantified. Methods: A longitudinal cohort study was conducted using employer-owned payroll-based register data of objective and day-to-day working hours and absences of one hospital district in Finland from 2014 to 2019 (n = 4931 employees). The working hour data included start and end of work shifts, any kind of absence from work (days off, sickness absence, parental leave), and employee's age, and sex. Daily work shifts and absences in 2014 and 2019 were used in sequence analysis. Generalized linear model was used to estimate how each identified sequence cluster was associated with sex and age. Results: We identified four sequence clusters: "Morning" (60% in 2014 and 56% in 2019), "Varying shift types" (22% both in 2014 and 2019), "Employee turnover" (13% in 2014 and 3% in 2019), and "Unstable employment (5% in 2014 and 19% in 2019). The analysis of transitions from one cluster to another between 2014 and 2019 indicated that most employees stayed in the same clusters, and most often in the "Varying shift types" (60%) and "Morning" (72%) clusters. The majority of those who moved, moved to the cluster "Morning" in 2019 from "Employee turnover" (43%), "Unstable employment" (46%) or "Varying shift types" (21%). Women were more often than men in the clusters "Employee turnover" and "Unstable employment", whereas older employees were more often in "Morning" and less often in the other cluster groups. Conclusion: Four clusters with different combinations of work shifts and absences were identified. The transition rates between work shifts and absences with five years in between indicated that most employees stayed in the same clusters. The likelihood of a working hour pattern characterized by "Morning" seems to increase with age. [ABSTRACT FROM AUTHOR]

Objective In terms of prevention, it is important to determine effects on cardiovascular disease (CVD) when some workplace psychosocial resources are high while others are low. The aim of the study was to assess the prospective relationship between clustering of workplace psychosocial resources and risk of CVD among employees. Methods We pooled data from three cohort studies of 135 669 employees (65% women, age 18-65 years and free of CVD) from Denmark, Finland and Sweden. Baseline horizontal resources (culture of collaboration and support from colleagues) and vertical resources (leadership quality and procedural justice) were measured using standard questionnaire items. Incident CVD, including coronary heart and cerebrovascular disease, was ascertained using linked electronic health records. We used latent class analysis to assess clustering (latent classes) of workplace psychosocial resources. Cox proportional hazard models were used to examine the association between these clusters and risk of CVD, adjusting for demographic and employment-related factors and pre-existing physical and mental disorders. Results We identified five clusters of workplace psychosocial resources from low on both vertical and horizontal resources (13%) to generally high resources (28%). High horizontal resources were combined with either intermediate [hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.74-0.95] or high (HR 0.88, 95% CI 0.78-1.00) vertical resources were associated with lower risks of CVD compared to those with generally low resources. The association was most prominent for cerebrovascular disease (eg, general high resources: HR 0.80, 95% CI 0.67-0.96). Conclusions Individuals with high levels of workplace psychosocial resources across horizontal and vertical dimensions have a lower risk of CVD, particularly cerebrovascular disease. [ABSTRACT FROM AUTHOR]

Although health care professionals' increased job demands and strain have generated much public debate in recent years, the way in which occupational therapists' job strain has developed remains unknown. To examine how Finnish occupational therapists working in municipalities experienced job demands and control in 2014–2018 compared with physiotherapists and registered nurses. Occupational therapists (OT, n = 107), physiotherapists (PT, n = 331) and registered nurses (RN, n = 1389) responded to repeated surveys in the Finnish Public Sector Study in 2014–2018. We used the Job Content Questionnaire and analyzed the data using repeated measures analysis of variance and multiple linear regression with generalized estimating equations to identify the trends and differences. More OTs had lower job demands and higher job control than PTs and RNs in each year of study. These differences were statistically significant. Most OTs had low job strain. The changes in job control and job demands of participants in different years were not statistically significant. The OTs consistently experienced low job strain as compared to the PTs and RNs. Developing good practices in OT's work may be beneficial for improving employee health and well-being and high-quality client care. [ABSTRACT FROM AUTHOR]

Purpose Employers increasingly use 'return to work' (RTW) coordinators to support work ability and extend working careers, particularly among employees with reduced work ability. We examined whether applying this model was associated with changes in employee sickness absence and disability retirements. Methods We used data from the Finnish Public Sector study from 2009 until 2015. Employees where the model was introduced in 2012 constituted the cases (n = 4120, one municipality) and employees where the model was not in use during the follow-up, represented the controls (n = 5600, two municipalities). We analysed risk of disability retirement in 2013–2015 and risk of sickness absence after (2013–2015) vs. before (2009–2011) intervention by case–control status. Results The incidence of disability retirement after the intervention was lower in cases compared to controls both in the total population (hazard ratio HR = 0.49, 95% CI 0.30–0.79) and in the subgroup of participants with reduced work ability (HR = 0.34, 95% CI 0.12–0.99). The risk of sickness absence increased from pre-intervention to post-intervention period both among cases and controls although the relative increase was greater among cases (RRpost- vs. pre-intervention = 1.26, 95% CI 1.14–1.40) than controls (RRpost- vs. pre-intervention = 1.03, 95% CI 0.97–1.08). In the group of employees with reduced work ability, no difference in sickness absence trends between cases and controls was observed. Conclusions These findings suggest that RTW-coordinator model may increase employee sickness absence, but decrease the risk of disability retirement, i.e., permanent exclusion from the labour market. [ABSTRACT FROM AUTHOR]

Objective This study aimed to examine duration of sickness absence due to knee osteoarthritis (OA) and sustained return to work (RTW) among municipal employees who had at least one compensated sickness absence period due to knee OA. The contribution of sociodemographic characteristics, diabetes and previous sickness absence were assessed. We differentiated between participants with and without total knee arthroplasty (TKA). Methods Data from 123 506 employees in the Finnish Public Sector Study were linked with national health and mortality register information. There were 3 231 sickness absence periods (2372 participants) due to knee OA in 2005-2011. Kaplan-Meier curves for sustained RTW were obtained and median time with inter-quartile range (IQR) calculated for those with and without TKA. Cox regression analyses were carried out in multivariable analyses. Results The median time to RTW from the beginning of sickness absence was 21-28 days when TKA was not related to sickness absence and 92-145 days when it was. Among participants with no TKA, age 60-64, nonsedentary work, diabetes, and previous sickness absences predicted longer time to RTW, while pain medication predicted a shorter time. Among participants with TKA, non-sedentary work and previous sickness absences predicted a longer time to RTW. Conclusions The clinical relevance of the difference in time to RTW between employees with or without TKA was substantial. Employees with knee OA working in physically demanding jobs need work modifications after TKA, and this calls for a dialog between occupational health care professionals and workplaces. [ABSTRACT FROM AUTHOR]

Background: There is inconsistent evidence that long working hours and night work are risk factors for sickness absence, but few studies have considered variation in the length of exposure time window as a potential source of mixed findings. We examined whether the association of long working hours and night work with sickness absence is dependent on the length of exposure to the working hour characteristics.Methods: We analysed records of working hours, night work and sickness absence for a cohort of 9226 employees in one hospital district in Finland between 2008 and 2019. The exposure time windows ranged from 10 to 180 days, and we used Cox's proportional hazards models with time-dependent exposures to analyse the associations between working-hour characteristics and subsequent sickness absence.Results: Longer working hours for a period of 10 to 30 days was not associated with the risk of sickness absence whereas longer working hours for a period of 40 to 180 days was associated with a lower risk of sickness absence. Irrespective of exposure time window, night work was not associated with sickness absence.Conclusions: It is important to consider the length of exposure time window when examining associations between long working hours and sickness absence, whereas the association between night work and sickness absence is not similarly sensitive to exposure times. [ABSTRACT FROM AUTHOR]

Objectives Data mining can complement traditional hypothesis-based approaches in characterizing unhealthy work exposures. We used it to derive a hypothesis-free characterization of working hour patterns in shift work and their associations with sickness absence (SA). Methods In this prospective cohort study, complete payroll-based work hours and SA dates were extracted from a shift-scheduling register from 2008 to 2019 on 6029 employees from a hospital district in Southwestern Finland. We applied permutation distribution clustering to time series of successive shift lengths, between-shift rest periods, and shift starting times to identify clusters of similar working hour patterns over time. We examined associations of clusters spanning on average 23 months with SA during the following 23 months. Results We identified eight distinct working hour patterns in shift work: (i) regular morning (M)/evening (E) work, weekends off; (ii) irregular M work; (iii) irregular M/E/night (N) work; (iv) regular M work, weekends off; (v) irregular, interrupted M/E/N work; (vi) variable M work, weekends off; (vii) quickly rotating M/E work, non-standard weeks; and (viii) slowly rotating M/E work, non-standard weeks. The associations of these eight working-hour clusters with risk of future SA varied. The cluster of irregular, interrupted M/E/N work was the strongest predictor of increased SA (days per year) with an incidence rate ratio of 1.77 (95% confidence interval 1.74-1.80) compared to regular M/E work, weekends off. Conclusions This data-mining suggests that hypothesis-free approaches can contribute to scientific understanding of healthy working hour characteristics and complement traditional hypothesis-driven approaches. [ABSTRACT FROM AUTHOR]

Purpose: Alternative duty work is a procedure that enables an employee with a short-term disability to perform modified duties as an alternative to sickness absence. We examined whether the implementation of an alternative duty policy was associated with reduced sickness absence in the Finnish public sector.Methods: Two city administrations (A and D) that implemented an alternative duty work policy to their employees (n = 5341 and n = 7538) served as our intervention cities, and two city administrations (B and C) that did not implement the policy represented the reference cities (n = 6976 and n = 6720). The outcomes were the number of annual days, all episodes, and short-term (< 10 days) episodes during the 2 years before versus the 2 years after the intervention year. We applied repeated measures negative binomial regression analyses, using the generalized estimating equations method and the difference-in-difference analysis to compare the intervention and control cities (adjusted for sex, age, type of job contract, occupational class).Results: During the five-year study period, the number of sickness absence days and episodes increased in both the intervention and control cities. Covariate-adjusted analysis of relative risk showed that the overall increase in post- versus pre-intervention sickness absence days was smaller in intervention City A, RR = 1.14 (95% CI = 1.09-1.21) than in control cities B and C, RR = 1.19 (95% CI =1.14-1.24), group × time interaction p < 0.02. In intervention City D, we found a corresponding result regarding all sickness absence episodes and short-term sickness absence episodes but not days.Conclusions: This follow-up suggests that implementing an alternative duty work policy may marginally decrease employees' sickness absences. [ABSTRACT FROM AUTHOR]

Background Heavy physical effort at work has been linked with disability pension, but the contribution of other ergonomic job exposures is less studied. We studied the independent and joint contributions of long-term exposure to (i) rotation of the back and (ii) repetitive movements to disability pension, particularly due to musculoskeletal disorders. Methods Exposures were measured with the Helsinki Health Study Job Exposure Matrix during 1996–2005 and linked to register data on employees of the City of Helsinki, Finland (n = 18 585). Outcomes were followed up during 2006–2015. Competing risk survival analyses were performed and synergy indices computed, adjusting for sociodemographic factors. Results Long-term exposure to rotation of the back was associated with disability pension due to any cause [age and sex-adjusted subhazard ratio (SHR) 2.39, 95% confidence interval (CI) 1.73–3.30], and specifically disability pension due to musculoskeletal disorders (SHR = 3.39, 95% CI 1.52–7.56) when compared to employees exposed to neither of the two exposures. Repetitive movements alone did not increase the risk of disability pension (all-cause SHR = 1.08, 95% CI 0.84–1.38, musculoskeletal SHR = 1.65, 95% CI 0.91–2.97). Employees with exposure to both rotation of the back and repetitive movements had the highest risk of disability pension due to musculoskeletal disorders (SHR = 5.98, 95% CI 3.85–9.28), but the interaction between exposures was additive rather than synergistic. Adjustment for education diluted the associations by 42–108%. Conclusion Long-term exposure to awkward work postures increased the risk of disability pension. Educational inequalities largely account for differences in occupational exposures. [ABSTRACT FROM AUTHOR]

Background: Smoking increases disability risk, but the extent to which smoking cessation reduces the risk of work disability is unclear. We used non-randomized nested pseudo-trials to estimate the benefits of smoking cessation for preventing work disability.Methods: We analysed longitudinal data on smoking status and work disability [long-term sickness absence (≥90 days) or disability pension] from two independent prospective cohort studies-the Finnish Public Sector study (FPS) (n = 7393) and the Health and Social Support study (HeSSup) (n = 2701)-as 'nested pseudo-trials'. All the 10 094 participants were smokers at Time 1 and free of long-term work disability at Time 2. We compared the work disability risk after Time 2 of the participants who smoked at Time 1 and Time 2 with that of those who quit smoking between these times.Results: Of the participants in pseudo-trials, 2964 quit smoking between Times 1 and 2. During the mean follow-up of 4.8 to 8.6 years after Time 2, there were 2197 incident cases of work disability across the trials. Quitting smoking was associated with a reduced risk of any work disability [summary hazard ratio = 0.89, 95% confidence interval (CI) 0.81-0.98]. The hazard ratio for the association between quitting smoking and permanent disability pension (928 cases) was of similar magnitude, but less precisely estimated (0.91, 95% CI 0.81-1.02). Among the participants with high scores on the work disability risk score (top third), smoking cessation reduced the risk of disability pension by three percentage points. Among those with a low risk score (bottom third), smoking cessation reduced the risk by half a percentage point.Conclusions: Our results suggest an approximately 10% hazard reduction of work disability as a result of quitting smoking. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To estimate differences in the strength and shape of associations between alcohol use and diagnosis‐specific sickness absence. Design: A multi‐cohort study. Participants (n = 47 520) responded to a survey on alcohol use at two time‐points, and were linked to records of sickness absence. Diagnosis‐specific sickness absence was followed for 4–7 years from the latter survey. Setting and participants: From Finland, we had population cohort survey data from 1998 and 2003 and employee cohort survey data from 2000–02 and 2004. From France and the United Kingdom, we had employee cohort survey data from 1993 and 1997, and 1985–88 and 1991–94, respectively. Measurements: We used standard questionnaires to assess alcohol intake categorized into 0, 1–11 and > 11 units per week in women and 0, 1–34 and > 34 units per week in men. We identified groups with stable and changing alcohol use over time. We linked participants to records from sickness absence registers. Diagnoses of sickness absence were coded according to the International Classification of Diseases. Estimates were adjusted for sex, age, socio‐economic status, smoking and body mass index. Findings: Women who reported drinking 1–11 units and men who reported drinking 1–34 units of alcohol per week in both surveys were the reference group. Compared with them, women and men who reported no alcohol use in either survey had a higher risk of sickness absence due to mental disorders [rate ratio = 1.51, 95% confidence interval (CI) = 1.22–1.88], musculoskeletal disorders (1.22, 95% CI = 1.06–1.41), diseases of the digestive system (1.35, 95% CI = 1.02–1.77) and diseases of the respiratory system (1.49, 95% CI = 1.29–1.72). Women who reported alcohol consumption of > 11 weekly units and men who reported alcohol consumption of > 34 units per week in both surveys were at increased risk of absence due to injury or poisoning (1.44, 95% CI = 1.13–1.83). Conclusions: In Finland, France and the United Kingdom, people who report not drinking any alcohol on two occasions several years apart appear to have a higher prevalence of sickness absence from work with chronic somatic and mental illness diagnoses than those drinking below a risk threshold of 11 units per week for women and 34 units per week for men. Persistent at‐risk drinking in Finland, France and the United Kingdom appears to be related to increased absence due to injury or poisoning. [ABSTRACT FROM AUTHOR]

Aims We examined differences in sickness absence in relation to at-risk drinking and abstinence, taking into account potential changes in consumption. Methods We used individual-participant data (n = 46,514) from four prospective cohort studies from Finland, France and the UK. Participants responded to a survey on alcohol use at two time points 4–6 years apart, and were linked to records of sickness absence for an ~6-year follow-up after the latter survey. Abstainers were those reporting no alcohol use in either survey. At-risk drinkers at T1 were labelled as 'former', at-risk drinkers at T2 as 'current' and at-risk drinkers at both times as 'consistent' at-risk drinkers. The reference group was low-risk drinkers at both times. Study-specific analyses were stratified by sex and socioeconomic status (SES) and the estimates were pooled using meta-analysis. Results Among men (n = 17,285), abstainers (6%), former (5%), current (5%) and consistent (7%) at-risk drinkers had an increased risk of sickness absence compared with consistent low-risk drinkers (77%). Among women (n = 29,229), only abstainers (12%) had a higher risk of sickness absence compared to consistent low-risk drinkers (74%). After adjustment for lifestyle and health, abstaining from alcohol was associated with sickness absence among people with intermediate and high SES, but not among people with low SES. Conclusions The U-shaped alcohol use—sickness absence association is more consistent in men than women. Abstinence is a risk factor for sickness absence among people with higher rather than lower SES. Healthy worker effect and health selection may partly explain the observed differences. Short summary In a pooled analysis from four cohort studies from three European countries, we demonstrated a U-shaped association between alcohol use and sickness absence, particularly among men. Abstinence from alcohol was associated with increased sickness absenteeism among both sexes and across socioeconomic strata, except those with low SES. [ABSTRACT FROM AUTHOR]

Background: The extent to which predictors of return to work (RTW) and recurrence of work disability episodes vary by age group is not well understood. Methods: We examined the associations of sociodemographic and clinical factors with RTW and recurrence after mental-disorder-related work disability episodes in a cohort of 10,496 Finnish public sector employees. Disability records were derived from national disability registers between 2005 and 2011. Effect modification by age was examined in age groups of 21–34, 35–50 and >50 years.Results: A total of 16,551 disability episodes from mental disorders were recorded. The likelihood of RTW was elevated in age group 21–34 (hazard ratio (HR) = 1.36, 95% confidence interval (CI) = 1.28–1.46) and 35–50 years (HR = 1.22, 95% CI = 1.18–1.26) compared to age group >50 years. The risk of a recurrent episode of work disability was higher in age groups >50 (HR = 1.29, 95% CI = 1.09–1.52) and 35–50 years (HR = 1.20, 95% CI = 1.03–1.41) compared to the youngest age group. Employees with depressive disorders were less likely to RTW than employees with neurotic, stress-related and somatoform disorders, and this difference increased with age. Low education was associated with increased risk of recurrent work disability episode in age groups of 50 years or younger, while no such association was observed in age group >50 years. Conclusions:The importance of depressive symptoms over neurotic, stress-related and somatoform disorders as predictors of delayed RTW increases with age, whereas educational differences in the recurrence of an episode diminish by age. [ABSTRACT FROM AUTHOR]

To determine the extent to which change in (i.e., start and end of) workplace bullying can be predicted by employee responses to standard workplace surveys. Responses to an 87-item survey from 48,537 Finnish public sector employees at T1 (2017–2018) and T2 (2019–2020) were analyzed with least-absolute-shrinkage-and-selection-operator (LASSO) regression. The predictors were modelled both at the individual- and the work unit level. Outcomes included both the start and the end of bullying. Predictive performance was evaluated with C-indices and density plots. The model with best predictive ability predicted the start of bullying with individual-level predictors, had a C-index of 0.68 and included 25 variables, of which 6 remained in a more parsimonious model: discrimination at work unit, unreasonably high workload, threat that some work tasks will be terminated, working in a work unit where everyone did not feel they are understood and accepted, having a supervisor who was not highly trusted, and a shorter time in current position. Other models performed even worse, either from the point of view of predictive performance, or practical useability. While many bivariate associations between socioeconomic characteristics, work characteristics, leadership, team climate, and job satisfaction were observed, reliable individualized detection of individuals at risk of becoming bullied at workplace was not successful. The predictive performance of the developed risk scores was suboptimal, and we do not recommend their use as an individual-level risk prediction tool. However, they might be useful tool to inform decision-making when planning the contents of interventions to prevent bullying at an organizational level. • We aimed to predict the start and the end of bullying based on workplace survey • The model with the best predictive ability and useability had a C-index of 0.66 • That model predicted the start of bullying with work, team, and leader traits • We do not recommend use at individual-level prediction • However, the results can be used when planning interventions to prevent bullying [ABSTRACT FROM AUTHOR]

Objective: The proportion of aging employees with cardiometabolic diseases, such as heart or cerebrovascular disease, diabetes and chronic hypertension is on the rise. We explored the extent to which health- and work-related factors were associated with the risk of disability pension among individuals with such cardiometabolic disease.Methods: A cohort of 4798 employees with and 9716 employees without a cardiometabolic disease were followed up for 7years (2005-2011) for disability pension. For these participants, register and survey data (from 2004) were linked to records on disability pensions. Cox proportional hazards modeling was used for estimating the hazard ratios (HR) with 95% confidence intervals (CI).Results: Individuals with heart or cerebrovascular disease had 2.88-fold (95% CI=2.50-3.31) higher risk of all-cause disability pension compared to employees with no cardiometabolic disease. Diabetes was associated with a 1.84-fold (95% CI=1.52-2.23) and hypertension a 1.50-fold (95% CI=1.31-1.72) increased risk of disability pension. Obesity in cases of diabetes and hypertension (15%) and psychological distress in cases of heart or cerebrovascular disease (9%) were the strongest contributing factors. All 12 health- and work-related risk factors investigated accounted for 24% of the excess work disability in hypertension, 28% in diabetes, and 11% in heart or cerebrovascular disease. Cause-specific analyses (disability pension due to mental, musculoskeletal and circulatory system diseases) yielded similar results.Conclusions: In this study, modifiable risk factors, such as obesity and mental comorbidity, predicted permanent exit from the labor market due to disability in individuals with cardiometabolic disease. [ABSTRACT FROM AUTHOR]

Background The role of socioeconomic status in work disability among employees with diabetes is not well known. We examined the association between socioeconomic status and work disability among employees with and without diabetes taking into account comorbid conditions. Methods We used individual participant data from three occupational cohorts from Finland, France and the UK (employees with diabetes, n=2170, age-matched and sex-matched controls without diabetes, n=4340). In all cohorts, survey data were linked with register data and the employees were followed up on average for 4.4 years. Socioeconomic status was based on occupational titles. Work disability (sickness absence and disability pension) was indexed as the numbers of disability days and episodes. The study-specific estimates were pooled using meta-analysis and effect modifications were studied with meta-regression. Results The average numbers of disability days and episodes per year were 1.5-3.5 times higher for persons with diabetes compared to those without. Among persons with diabetes, the risk of work disability was almost four times higher in the lowest compared to the highest occupational position (relative index of inequality (RII) for days 3.82; 95% CI 2.77 to 5.56; RII for episodes 3.80; 95% CI 3.13 to 4.61). This association was consistent in both sexes and regardless of comorbid conditions. In relative terms, the association of socioeconomic status and work disability was similar among those free of diabetes. Conclusions A strong socioeconomic gradient in work disability was observed among people with and without diabetes. [ABSTRACT FROM AUTHOR]

Purpose: Mental disorders are the leading cause of work disability among young adults. This study examined whether distinct classes could be identified among young adults on the basis of medical history before receiving a disability pension due to a mental disorder.Methods: Medical history was obtained from pension applications and attached medical certificates for 1163 individuals aged 18-34 years who, in 2008, received a disability pension due to a mental disorder. Using latent class analysis, 10 clinical and individual adversities and their associations with sex, age and diagnostic category were examined.Results: Three classes were identified: childhood adversity (prevalence, 33%), comorbidity (23%), and undefined (44%). The childhood adversity class was characterized by adverse events and symptoms reported during childhood and it associated with depressive disorders. The comorbidity class was characterized by comorbid mental disorders, suicide attempts and substance abuse and associated with younger age and bipolar disorder. The undefined class formed no distinct profile; individuals in this class had the lowest number of adversities and it associated with psychotic disorders.Conclusions: The identification of subgroups characterized by childhood circumstances and comorbidity may help planning of prevention and support practices for young adults with mental disorders and risk of work disability. [ABSTRACT FROM AUTHOR]

Background: Environmental factors may affect adolescents' eating habits and thereby body weight. However, the contribution of school neighbourhood environment is poorly understood. This study examined the association between proximity of a fast-food outlet or grocery store to school and adolescents' eating habits and overweight. Methods: Participants were 23 182 adolescents (mean age 15 years) who responded to a classroom survey in 181 lower secondary schools in Finland (2008-09). School location was linked to data on distance from school to the nearest fast-food outlet or grocery store (≤100 m, 101−500 m, >500 m) using global positioning system-coordinate databases. Outcomes were irregular eating habits (skipping breakfast, skipping free school lunch, skipping free school-provided snacks and not having family dinners), the accumulation of these habits and overweight, including obesity (body mass index ≥ 25 kg/m2). Results: Thirteen percentage of the participants were overweight. Having a fast-food outlet or grocery store near school was associated with skipping often breakfast and free school lunch, and the accumulation of irregular eating habits. The proximity of a fast-food outlet or grocery store was associated with a 1.25-fold (95% confidence interval 1.03-1.52) risk of overweight among adolescent with a low socioeconomic status but not among those with higher socioeconomic status. This association was partly (12%) explained by the accumulation of irregular eating habits. Conclusions: Among adolescents from low socioeconomic background, the presence of fast-food retailers near schools is associated with accumulation of irregular eating habits and greater overweight. These findings suggest that obesogenic school neighbourhoods may contribute to social inequalities in overweight. [ABSTRACT FROM AUTHOR]

The findings from this study will help employers, health professionals, and employees themselves notice that work ability in the last years of work before pensionable age could be supported by paying more attention to employees who have work stress or sleep problems in mid-life. Objective: This study examined whether mid-life work stress, defined as job strain and effort-reward imbalance (ERI), predicts work ability trajectories observed 12 years preceding the individual pensionable age. In addition, the role of sleep problems as a mediator in these associations was examined. Methods: Survey data were collected from 2707 Finnish municipal employees. Results: Identified work ability trajectories were "stable excellent," "stable good," "moderate," and "low decreasing." Baseline job strain and ERI were associated with a greater likelihood of belonging to impaired work ability trajectories when compared with "stable good" trajectory. Baseline sleep problems explained the association of job strain by 38% and of ERI by 54%. Conclusions: Mid-life work stress is associated with work ability in the last years preceding pensionable age. Sleep problems might be a potential mediator in these associations. [ABSTRACT FROM AUTHOR]

Objectives: Research on temporary employment as a risk factor for work disability due to depression is mixed, and few studies have measured work disability outcome in detail. We separately examined the associations of temporary employment with (i) the onset of work disability due to depression, (ii) the length of disability episodes, and (iii) the recurrence of work disability, taking into account the possible effect modification of sociodemographic factors. Methods: We linked the prospective cohort study data of 107 828 Finnish public sector employees to national registers on work disability (>9 days) due to depression from January 2005 to December 2011. Results: Disability episodes were longer among temporary than permanent employees after adjustment for age, sex, level of education, chronic somatic disease, and history of mental/behavioral disorders [cumulative odds ratio (COR) 1.37, 95% confidence interval (95% CI) 1.25-1.51]. The association between temporary employment and the length of depression-related disability episodes was more pronounced among participants with a low educational level (COR 1.95, 95% CI 1.54-2.48) and older employees (>52 years; COR 3.67, 95% CI 2.83-4.76). The association was weaker in a subgroup of employees employed for ≥50% of the follow-up period (95% of the original sample). Temporary employment was not associated with the onset or recurrence of depression-related work disability. Conclusions: Temporary employment is associated with slower return to work, indicated by longer depressionrelated disability episodes, especially among older workers and those with a low level of education. Continuous employment might protect temporary employees from prolonged work disability. [ABSTRACT FROM AUTHOR]

Objectives We examined whether having a high percentage of pupils with special educational needs (SEN) in basic education schools increases the risk of sickness absence among teachers and whether this risk is dependent on the pupil-teacher ratio (PTR), an indicator of teacher resources at school. Methods We obtained register data on 8089 teachers working in 404 schools in 10 municipalities in Finland during the school year 2004-2005. We used multilevel multinomial regression models to examine the risk of teachers' short- and long-term sickness absence in relation to the percentage of SEN pupils and the PTR at school. We tested the equality of trends in groups with high and low the PTR using PTR × SEN interaction term. Results After adjustment for teacher and school characteristics, the risk for long-term absences was higher among teachers at schools with a high percentage of SEN pupils than among teachers at schools with a low percentage of SEN pupils [odds ratio (OR) 1.5, 95% confidence interval (95% CI) 1.2-1.8). This was also the case for short-term absences (OR 1.4, 95% CI 1.2-1.7). In analyses stratified by the PTR levels, the association between the percentage of SEN pupils and long-term absences was 15% higher among teachers with a high PTR than among those with a low PTR (P-value for interactional. 10). Conclusions Teachers' sickness absenteeism seems to increase with a higher percentage of SEN pupils, especially when the PTR is high. Teacher resources at schools that have a high percentage of SEN pupils should be well maintained to ensure the health of teachers. [ABSTRACT FROM AUTHOR]

Background: Although health is an important determinant of sickness absence, social relationships at the workplace may also affect levels of sick leaves. This study examined whether students’ self-assessed satisfaction with school predicted sickness absence among teachers in Finnish secondary schools. Methods: We measured school satisfaction of 17 033 students aged 14–16 years from 90 schools by a survey (the School Health Promotion Study) and aggregated school-specific scores of students’ school satisfaction. For analysis, we linked these school-level data to records of sickness absence in the survey year and the following year among 2364 teachers working in the same schools (the 10-Town Study). For sickness absence longer than 9 days, we obtained diagnoses from national health registers. Results: Multilevel Poisson and logistic regression models adjusted for relevant baseline covariates showed a rate ratio of 1.2 [95% confidence interval (95% CI): 1.0–1.5] for long-term (>3 days) sickness absence among teachers working in schools with two lowest thirds of student satisfaction compared with teachers in schools with high student satisfaction. The corresponding odds ratio (OR) was higher for sickness absence with a psychiatric diagnosis (OR 1.9, 95% CI: 1.1–3.2), more specifically, neurotic and stress-related disorders (OR 2.6, 95% CI: 1.2–5.9). Students’ school satisfaction was not associated with teachers’ short-term (1–3 days) sick leaves. Conclusions: These data suggest a link between social relationships at school, as indexed by students’ school satisfaction, and teachers’ sick leaves, with the strongest associations seen for absences with mental health diagnoses. [ABSTRACT FROM AUTHOR]

Background: Uncertainty remains whether associations for psychological distress and sickness absence (SA) observed between and within individuals differ, and whether age, gender and work-related factors moderate these associations.Methods: We analyzed SA records of 41,184 participants of the Finnish Public Sector study with repeated survey data between 2000 and 2016 (119,024 observations). Psychological distress was measured by the General Health Questionnaire (GHQ-12), while data on SA days were from the employers' registers. We used a hybrid regression estimation approach adjusting for time-variant confounders-age, marital status, occupational class, body mass index, job contract type, months worked in the follow-up year, job demand, job control, and workplace social capital-and time-invariant gender (for between-individual analysis).Results: Higher levels of psychological distress were consistently associated with SA, both within- and between-individuals. The within-individual association (incidence rate ratio (IRR) 1.68, 95% CI 1.61-1.75 for SA at high distress), however, was substantially smaller than the between-individual association (IRR 2.53, 95% CI 2.39-2.69). High levels of psychological distress had slightly stronger within-individual associations with SA among older (>45 years) than younger employees, lower than higher occupational class, and among men than women. None of the assessed work unit related factors (e.g. job demand, job control) were consistent moderators.Limitations: These findings may not be generalizable to other working sectors or cultures with different SA policies or study populations that are male dominated.Conclusions: Focus on within-individual variation over time provides more accurate estimates of the contribution of mental health to subsequent sickness absence. [ABSTRACT FROM AUTHOR]

Although nurse understaffing and limited nursing work experience may affect hospital patients' risk of mortality, relatively little longitudinal patient-level evidence on these associations is available. Hospital administrative data could provide important information about the level of staffing, nurses' work experience and patient mortality over time. To examine whether daily exposure to nurse understaffing and limited nursing work experience is associated with patient mortality, using patient-level data with different exposure time windows and accounting for several patient-related characteristics. This longitudinal register-based study combined administrative data on patients (clinical database Auria) and employees (Titania® shift-scheduling) from one hospital district in Finland in 2013–2019, covering a total of 254,446 hospital stays in 40 units. We quantified nurse understaffing as the number of days with low nursing hours in relation to target hours (< 90 % of the annual unit median), and limited work experience as the number of days with a low proportion of nurses with > 3 years of in-hospital experience, and those aged over 25 (< 90 % of the annual unit median). We used two survival model designs to analyze the associations between nurse understaffing and limited nursing work experience and the in-hospital mortality of the patients: we considered these exposures during the first days in hospital and as a cumulative proportion of days with suboptimal staffing during the first 30 days. In total, 1.5 % (N = 3937) of the hospital stays ended in death. A 20 % increase in the proportion of days with nurse understaffing was associated with an increased, 1.05-fold mortality risk at the patient level (95 % confidence interval, 1.01–1.10). The cumulative proportion of days with limited nursing work experience, or the combination of nurse understaffing and limited work experience were not associated with increased risk of death among all patients. However, both indicators of limited nursing work experience were associated with an increased mortality risk among patients with comorbidities (HR 1.05, 95 % CI 1.02–1.08 and HR 1.05, 95 % CI 1.00–1.10, respectively). Nurse understaffing was associated with a slight, but a potentially critical increase in patient in-hospital mortality. Limited nursing work experience was associated with increased in-hospital mortality in a subgroup of patients with comorbidities. Increased use of administrative data on planned and realized working hours could be a routine tool for reducing avoidable in-hospital mortality. [ABSTRACT FROM AUTHOR]

Background: Short intervals between shifts, known as quick returns, have been linked to adverse health effects, and increased risk of occupational accidents, particularly among healthcare employees. To safeguard employee health, the 2020 reform of Working Time Act in Finland limited rest periods under 11 h in irregular shift work., Objective: To evaluate the changes in quick returns following the 2020 reform of the Working Time Act in Finland and their association with sickness absence among public healthcare employees., Design and Methods: This observational longitudinal study, analysed as a quasi-experiment used a difference-in-differences regression analysis with unit and time fixed effects and robust standard errors. We assessed changes in sickness absence from 2019 to 2021 across hospital work units. The study compared units mandated to limit quick returns (Treatment group; 416 units, over 20,500 employees, 72 % in nursing) with units that had low levels of quick returns prior the reform and did not need to limit quick returns (Control group; 37 units, over 1700 employees, 70 % in nursing). The analysis considered local agreements permitting quick returns, using both intention-to-treat and per-protocol approaches. Sensitivity analysis included regression models with unit level covariates and inverse probability weighting to adjust for initial differences., Results: The per-protocol approach and simple regression analysis with fixed effects for unit and time over 2019-2020 showed a less pronounced increase in sickness absence by -0.7 percentage points (95 % confidence interval [CI]: -1.3 to -0.1) for the treatment group compared to the control group, indicating a 13 % lower rate of sickness absence. For the period 2019-2021, the estimate was -0.5 percentage points (95 % CI: -1.0 to 0.0). When incorporating covariates and inverse probability weighting, the estimates were more substantial with narrower confidence intervals: -0.9 percentage points (95 % CI: -1.4 to -0.3) for 2019-2020, and - 0.6 percentage points (95 % CI: -1.2 to -0.1) for 2019-2021. The estimates from the intention-to-treat approach were consistent with the per-protocol results., Conclusion: The Working Time Act reform reduced quick returns, and after the reform, the reduction was associated with a smaller increase in sickness absence among healthcare employees. Policymakers and nursing managers should evaluate and adjust the frequency of quick returns to achieve the potential effects on employee well-being, health, and operational efficiency, which in this study was indicated by the reduction in sickness absence., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To identify trajectories of work ability from pre-COVID to post-COVID-19 pandemic period and to examine work unit characteristics associated with these trajectories., Methods: The study population was a cohort of Finnish public sector employees (n=54 651) followed from 2016 until 2022. We used trajectory analysis to identify trajectories of work ability and multinomial regression to examine their associations with prepandemic work unit characteristics and pandemic-related changes at workplaces., Results: We identified three trajectories of work ability: (1) suboptimal work ability decreasing over time (12%); (2) relatively consistent good work ability (73%) and (3) consistent optimal work ability (15%). The strongest associations with belonging to the suboptimal work ability trajectory were found for employees in work units characterised by high job strain (OR 2.29, 95% CI 1.82 to 2.88), poor team climate (OR 0.74, 95% CI 0.64 to 0.86) and low organisational justice (OR 0.64, 95% CI 0.57 to 0.72) when compared with the most optimal trajectory. The least favourable work ability trajectory was also associated with team reorganisation (OR 1.22, 95% CI 1.04 to 1.44) and a low share of those working from home (OR 0.86, 95% CI 0.78 to 0.94) during the pandemic., Conclusion: Prepandemic psychosocial risk factors and pandemic-induced changes at work were associated with poor and declining work ability during the COVID-19 pandemic. Employers and occupational health services should better identify and support vulnerable employees to enhance their work participation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ Group.)

Objective: The objective of this study is to examine the feasibility of using survey data to identify factors that predict commute mode choice., Design: The study design is cross-sectional., Setting: Survey data from the Finnish Public Sector study (2020) were used., Participants: 42 574 public sector employees, of whom 10 983 were selected for the final sample. These included employees with 5 km or less commuting distances and those working full-time onsite or partly remotely. The mean age was 46 (SD 11) years, and 84% were women., Primary Outcomes: Commute by (1) bike or foot (an active mode) during summer and winter weather and (2) by car (a passive mode) during summer and winter weather., Methods: Using logistic Lasso (least-absolute-shrinkage-and-selection-operator) regression, we developed and tested a prediction model for short commutes of 5 km or less to identify the characteristics of employees most likely to commute actively during summer and winter weather and passively during summer and winter weather., Results: All models had a good predictive ability with a C-index of 0.82, 0.77, 0.72 and 0.71. Cycling and walking during summer weather were predicted by shorter commutes, higher physical activity, lower body mass index (BMI), female sex and higher team psychological safety. Predictors of cycling and walking during winter weather were shorter commute length, higher physical activity, lower BMI and higher age. Commuting by car during summer weather was predicted by longer journey length, higher BMI, lower physical activity, male sex and having children 7-18 years old living at home. Predictors of driving during winter weather were almost identical, but the male sex was replaced by having a spouse., Conclusions: We identified the correlates of active and passive commute choice in different weather conditions with eight variables. This information can be used to develop and target interventions to promote sustainable and healthy commuting modes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Objective: Leisure-time physical activity (PA) has been hypothesized to reduce the likelihood of occupational injuries, but it is unclear whether this association varies between workplace and commuting injuries. The aim of this study was to examine the association between PA and risk of workplace and commuting injuries., Methods: Data were derived from the Finnish Public Sector study including 82 716 person-observations (48 116 participants). PA was requested repeatedly in four questionnaire surveys between 2000-2012. The average level of PA from two subsequent questionnaires was used to assess long-term PA. To obtain a 1-year incidence of injuries, participants were linked to occupational injury records from the national register. Logistic regression analysis with generalized estimating equations was used to examine the association between PA and injury risk. The analysis was adjusted for age, sex, education, work schedule, job demand, sleep difficulties, cardiovascular diseases, diabetes, and depression for workplace and commuting injuries, and workplace injuries were additionally adjusted for physical heaviness of an occupation and injury risk by occupation., Results: Higher level of PA was associated with a lower risk of workplace injuries compared to inactive participants [odds ratio (OR) 0.85, 95% confidence interval (CI) 0.73-0.98]. This association was most marked in the ≥50-year-old age group (OR 0.78, 95% CI 0.64-0.99). No association between the PA and the risk for commuting injuries was observed., Conclusion: Higher PA is associated with lower risk of workplace injuries particularly among older employees.

Objective: This study aimed to investigate (i) the risk of work disability (>10-day sickness absence spell or disability pension) due to common mental disorders (CMD) among social workers compared with other health and social care, education, and non-human service professionals and (ii) whether the risk was mediated by job stress., Methods: A cohort of 16 306 public sector professionals in Finland was followed using survey data from baseline (2004 or if not available, 2008) on job stress [job strain or effort-reward imbalance (ERI)] and register data on work disability due to CMD from baseline through 2011. A Cox proportional hazards model was used to analyze the risk of work disability due to CMD between three occupation-pairs in a counterfactual setting, controlling for age, sex, job contract, body mass index, alcohol risk use, smoking, and physical inactivity., Results: Social workers' job stress was at higher level only when compared to education professionals. Thus, the mediation hypothesis was analyzed comparing social workers to education professionals. Social workers had a higher risk of work disability due to CMD compared with education professionals [hazard ratio (HR) 2.08, 95% confidence interval (CI) 1.58-2.74]. This HR was partly mediated by job strain (24%) and ERI (12%). Social workers had a higher risk of work disability than non-human service professionals (HR 1.54, 95% CI 1.13-2.09), but not compared with other health and social care professionals., Conclusions: Job stress partly mediated the excess risk of work disability among social workers only in comparison with education professionals.

Background: Ageing hallmarks, characterising features of cellular ageing, have a role in the pathophysiology of many age-related diseases. We examined whether obesity is associated with an increased risk of developing such hallmark-related diseases., Methods: In this multicohort study, we included people aged 38-72 years with data on weight, height, and waist circumference measured during a clinical examination at baseline between March 13, 2006, and Oct 1, 2010, from the UK Biobank with follow-up until Nov 12, 2021. To test reproducibility of the findings (replication analysis), we used data from people aged 40 years or older included in the Finnish Public Sector study and the Finnish Health and Social Support study who responded to the study surveys, had data on BMI, and were successfully linked to electronic health records from national registers up to Dec 31, 2016. Obesity and clinical characteristics were assessed at baseline. Via linkage to national health records, participants were followed up for 83 diseases related to nine ageing hallmarks (genomic instability, telomere attrition, epigenetic alterations, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication). Outcomes were the first instance of hallmark-related disease, in addition to co-occurrence of three or more hallmark-related diseases and mortality., Findings: 496 530 adults (mean age 57·0 years [SD 8·1]) from the UK Biobank were included in the primary analysis, and 83 249 (mean age 48·2 years [6·4]) adults from the Finnish cohorts were included in the replication analysis. Median follow-up was 12·7 years (IQR 12·0-13·4) in the UK Biobank and 14·0 years (8·0-15·0) in the Finnish cohorts. After adjusting for demographic characteristics, lifestyle factors, and depression, UK Biobank participants with obesity (BMI ≥30·0 kg/m 2 ) had a 1·40 (95% CI 1·38-1·41) times higher hazard ratio for the first hallmark-related disease than those with a healthy weight (BMI 18·5-24·9 kg/m 2 ). The corresponding hazard ratios for three co-occurring diseases were 2·92 (95% CI 2·64-3·22) for deregulated nutrient sensing, 2·73 (2·46-3·02) for telomere attrition, 2·33 (2·10-2·60) for epigenetic alterations, 2·30 (2·14-2·48) for mitochondrial dysfunction, 2·23 (2·04-2·45) for stem cell exhaustion, 2·02 (1·89-2·16) for altered intercellular communication, 2·01 (1·89-2·15) for cellular senescence, 1·83 (1·67-2·00) for loss of proteostasis, and 1·39 (1·27-1·52) for genomic instability. These findings were replicated in the Finnish cohorts. In both studies, the associations between other risk factors (low education, unhealthy dietary factors [available only in the UK Biobank], smoking, high alcohol consumption, physical inactivity, and depression) and hallmark-related diseases were weaker than those with obesity. 45-60% of the excess mortality in people with obesity was attributable to hallmark-related diseases., Interpretation: Obesity might have an important role in the development of diseases associated with cellular ageing. Tackling ageing mechanisms could potentially help to reduce the disease and mortality burden resulting from the obesity epidemic., Funding: Wellcome Trust, UK Medical Research Council, US National Institute on Aging, Academy of Finland, and Finnish Foundation for Cardiovascular Research., Translations: For the German and Finnish translations of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Metabolic bariatric surgery the reduces risk of new-onset type 2 diabetes in individuals with obesity, but it is unclear whether the benefit varies by sex, age, or socioeconomic status. The aim was to assess the risk of new-onset type 2 diabetes after metabolic bariatric surgery in these subgroups., Methods: The Finnish Public Sector study, a follow-up study with matched controls nested in a large employee cohort, included patients without type 2 diabetes and with a diagnosis of obesity or self-reported BMI of at least 35 kg/m2. For each patient who had laparoscopic metabolic bariatric surgery (2008-2016), two propensity-score matched controls were selected. New-onset type 2 diabetes was ascertained from linked records from national health registries., Results: The study included a total of 917 patients and 1811 matched controls with obesity. New-onset type 2 diabetes was diagnosed in 15 of the patients who had metabolic bariatric surgery (4.1 per 1000 person-years) and 164 controls (20.2 per 1000 person-years). The corresponding rate ratio (RR) was 0.20 (95% c.i. 0.12 to 0.35) and the rate difference (RD) was -16.1 (-19.8 to -12.3) per 1000 person-years. The risk reduction was more marked in individuals of low socioeconomic status (RR 0.10 (0.04 to 0.26) and RD -20.6 (-25.6 to -15.5) per 1000 person-years) than in those with higher socioeconomic status (RR 0.35 (0.18 to 0.66) and RD -11.5 (-16.9 to -6.0) per 1000 person-years) (Pinteraction = 0.017). No differences were observed between sexes or age groups., Conclusion: Metabolic bariatric surgery was associated with a reduced risk of new-onset type 2 diabetes in men and women and in all age groups. The greatest benefit was observed in individuals of low socioeconomic status., (© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.)

Objectives: To investigate if the Jenkins Sleep Scale (JSS) demonstrates sex-related differential item functioning (DIF)., Design: Cross-sectional study., Setting: Survey data from the Finnish Public Sector study (2015-2017)., Participants: 77 967 employees in the Finnish public sector, with a mean age of 51.9 (SD 13.1) years and 82% women., Outcome Measures: Item response theory estimates: difficulty and discrimination parameters of the JSS and differences in these parameters between men and women., Results: The mean JSS total score was 6.4 (4.8) points. For all four items of the JSS, the difficulty parameter demonstrated a slight shift towards underestimation of the severity of sleep difficulties. The discrimination ability of all four items was moderate to high. For the JSS composite score, overall discrimination ability was moderate (0.98, 95% CI 0.97 to 0.99). Mild uniform DIF (p<0.001) was seen: two items showed better discrimination ability among men and two others among women., Conclusions: The JSS showed overall good psychometric properties among this healthy population of employees in the Finnish public sector. The JSS was able to discriminate people with different severities of sleep disturbances. However, when using the JSS, the respondents might slightly underestimate the severity of these disturbances. While the JSS may produce slightly different results when answered by men and women, these sex-related differences are probably negligible when applied to clinical situations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Overweight/obesity and strenuous working conditions are associated with work disability, but their joint contributions to sickness absence (SA) are unknown. We aimed to examine their joint contributions to SA periods of 1-7 and ≥8 days., Methods: Self-reported data on body mass index and working conditions, including perceived physically and mentally strenuous work and hours per day spent in heavy physical work, were linked to the employer's SA register for the City of Helsinki, Finland, employees (n = 4,323, women 78%) who were 19-39 years old at baseline. We calculated rate ratios (RRs) and 95% confidence intervals (CIs) for SA periods using negative binomial regression models among participants with healthy weight and overweight/obesity, with and without exposure to strenuous working conditions. The mean follow-up time was 2.1 years., Results: Participants with overweight/obesity and exposure to physically strenuous working conditions had the highest age- and gender-adjusted RRs for SA periods of both 1-7 and ≥8 days (physically strenuous work: RR: 1.38, CI: 1.25-1.52, and RR: 1.87, CI: 1.60-2.18, respectively; ≥3 h per day spent in physical work: RR: 1.40, CI: 1.26-1.55 and 2.04, CI: 1.73-2.40, respectively). The interaction between overweight/obesity and physically strenuous working conditions was additive for SA periods of 1-7 days and weakly synergistic for SA periods of ≥8 days. For mentally strenuous work, participants with overweight/obesity and exposure to mentally strenuous work had the highest age-adjusted RRs for SA periods of ≥8 days, and the interaction was additive., Conclusion: The joint contributions of overweight/obesity and exposure to strenuous working conditions to SA should be considered when aiming to reduce employees' SA. Employers might benefit from providing employees adequate support for weight management and adherence to healthy lifestyles while improving employees' working conditions., (© 2023 The Author(s). Published by S. Karger AG, Basel.)

Background: Active commuting, such as walking or cycling to work, can be beneficial for health. However, because within-individual studies on the association between change in active commuting and change in health are scarce, the previous results may have been biased due to unmeasured confounding. Additionally, prior studies have often lacked information about commuting distance., Methods: We used two waves (2020, T1 and 2022, T2) of self-report data from the Finnish Public Sector study (N = 16,881; 80% female) to examine the within- and between associations (in a hybrid model) between active commuting and health. Exposure was measured by actively commuted kilometers per week, that is, by multiplying the number of walking or cycling days per week with the daily commuting distance. The primary outcome, self-rated health, was measured at T1 and T2. The secondary outcomes, psychological distress, and sleep problems were measured only at T2 and were therefore analyzed only in a between-individual design., Results: After adjustment for potential time-varying confounders such as socioeconomic factors, body mass index, and health behaviors, an increase equivalent to 10 additional active commuting kilometers per week was associated with a small improvement in self-rated health (within-individual unstandardized beta = 0.01, 95% CI 0.01-0.02; between-individual unstandardized beta = 0.03, 95% CI 0.02-0.04). No associations were observed between changes in active commuting and psychological distress or sleep problems., Conclusions: An increase in active commuting may promote self-rated health. However, increase of tens of additional kilometers in commuting every day may be required to produce even a small effect on health., Competing Interests: Declaration of Competing Interest The authors declare that there are no conflicts of interests., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: To develop a risk prediction algorithm for identifying work units with increased risk of violence in the workplace., Design: Prospective cohort study., Setting: Public sector employees in Finland., Participants: 18 540 nurses, social and youth workers, and teachers from 4276 work units who completed a survey on work characteristics, including prevalence and frequency of workplace violence/threat of violence at baseline in 2018-2019 and at follow-up in 2020-2021. Those who reported daily or weekly exposure to violence or threat of violence daily at baseline were excluded., Exposures: Mean scores of responses to 87 survey items at baseline were calculated for each work unit, and those scores were then assigned to each employee within that work unit. The scores measured sociodemographic characteristics and work characteristics of the work unit., Primary Outcome Measure: Increase in workplace violence between baseline and follow-up (0=no increase, 1=increase)., Results: A total of 7% (323/4487) of the registered nurses, 15% (457/3109) of the practical nurses, 5% of the social and youth workers (162/3442) and 5% of the teachers (360/7502) reported more frequent violence/threat of violence at follow-up than at baseline. The area under the curve values estimating the prediction accuracy of the prediction models were 0.72 for social and youth workers, 0.67 for nurses, and 0.63 for teachers. The risk prediction model for registered nurses included five work unit characteristics associated with more frequent violence at follow-up. The model for practical nurses included six characteristics, the model for social and youth workers seven characteristics and the model for teachers included four characteristics statistically significantly associated with higher likelihood of increased violence., Conclusions: The generated risk prediction models identified employees working in work units with high likelihood of future workplace violence with reasonable accuracy. These survey-based algorithms can be used to target interventions to prevent workplace violence., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Few risk prediction scores are available to identify people at increased risk of work disability, particularly for those with an existing morbidity. We examined the predictive performance of disability risk scores for employees with chronic disease. We used prospective data from 88,521 employed participants (mean age 43.1) in the Finnish Public Sector Study including people with chronic disorders: musculoskeletal disorder, depression, migraine, respiratory disease, hypertension, cancer, coronary heart disease, diabetes, comorbid depression and cardiometabolic disease. A total of 105 predictors were assessed at baseline. During a mean follow-up of 8.6 years, 6836 (7.7%) participants were granted a disability pension. C-statistics for the 8-item Finnish Institute of Occupational Health (FIOH) risk score, comprising age, self-rated health, number of sickness absences, socioeconomic position, number of chronic illnesses, sleep problems, BMI, and smoking at baseline, exceeded 0.72 for all disease groups and was 0.80 (95% CI 0.80-0.81) for participants with musculoskeletal disorders, 0.83 (0.82-0.84) for those with migraine, and 0.82 (0.81-0.83) for individuals with respiratory disease. Predictive performance was not significantly improved in models with re-estimated coefficients or a new set of predictors. These findings suggest that the 8-item FIOH work disability risk score may serve as a scalable screening tool in identifying individuals with increased risk for work disability., (© 2023. The Author(s).)